Healthcare Provider Details

I. General information

NPI: 1588691364
Provider Name (Legal Business Name): ELISHEVA FLINK MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ELISHEVA HETTINGER MD

II. Dates (important events)

Enumeration Date: 06/27/2006
Last Update Date: 12/11/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

516 E. NIZHONI BLVD.
GALLUP NM
87301-1337
US

IV. Provider business mailing address

80 MARCUS DR PROVIDER ENROLLMENT
MELVILLE NY
11747-4230
US

V. Phone/Fax

Practice location:
  • Phone: 505-722-1000
  • Fax: 505-722-1256
Mailing address:
  • Phone: 631-391-7887
  • Fax: 631-454-4163

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number201650
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: